An ongoing discussion of the changes and frustrations with medical care by an observer, participant and active provider of it.

Sunday, September 30, 2012

Friday Morning Overload

Somewhere mid-morning on Friday I lost control. Things were perking along very nicely and then suddenly (or so it seemed to me), I was nearly an hour behind. Up until then even my EHR notes were signed at the end of each visit. Perhaps it is my German heritage, but my skin begins to crawl when patients wait more than fifteen minutes. For years it has been a matter of pride that they rarely waited longer than five or ten minutes and frequently they were seen within a minute or two of their appointment time. Nor did patients feel they were getting short shrift from me. My scheduling clerk knew her business and the patients well enough to pad an appointment when necessary. In the last three months that has not been the case. Hopefully this is temporary due to the extra time involved in learning our new documenting system but being behind brought me to a reflection on the importance of timely appointments.

Sometimes, no matter how good my intentions, the cards are stacked against me--Mrs. Jones lost her job and her mother in the same month; Mr. Bausier came in for a cold but just happened to mention the pressure sensation in his chest that seems to be more frequent and is associated with exertion; and in listening to Mrs. Roberts' heart it is obvious that the rhythm is just not right. And all in the same morning. Other times, it's more personal--I'm talking to a patient whose daughter went to high school with mine and we have to catch up or my favorite French national comes in who prefers to tell me her medical problems in her native tongue. Not because it's better for her but she knows I need the practice.

On Friday, my schedule was so off that by the twelfth of thirteen patients that morning my sugar was low, my mood was cranky, and my thought processes had slowed to a crawl. Frustratingly, somewhere in the brain fog I recognized those last two patients did not get my best care. Did they recognize my distress or just think that Dr. Nieder didn't care about their needs? Statistically patients have a problem speaking up for themselves in a doctor's office[1,2] and in my own uncomfortable state of mind it is unlikely I would have picked up on their discomfort!

Someday, hopefully soon, the office will find the right balance in scheduling for our new system. For now, I'm taking a lot of deep breaths and hoping that patients know I still respect their time and am struggling to give them good care under difficult circumstances.

Kathy A Nieder MD

A Family Practice physician since 1984, Dr. Nieder has watched the evolution (and devolution) of Health "care" over the years. She decided to add her voice to the discussion by making observations of the practice of medicine today, a time when the negatives often seem to outweigh the positives as patients and doctors become increasingly disenfranchised by the fragmentation of medical care. All views are solely her own.

Kathy has been fascinated by "tech" since she bought her first Apple computer for the family in 1987. She is interested in Social Media in healthcare as well as smartphone apps and their impact on patient care, especially in primary care.

She is an employed physician for Baptist Medical Associates in Louisville, KY. She enjoys partnering with her patients and believes patients who are well-informed and take an active role in their own well-being make for healthier, more satisfied people who make better lifestyle choices.

As a "primary care doc", Dr. Nieder advocates for PHYSICIAN led teams that embrace patients in not only the chronic illness setting but in preventive programs as well.

About.me

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